Understanding the Bishop Score and Natural Labor Induction

Written By Allyson Owen

I’m going to start a series of blog posts to help educate and empower the lovely pregnant mamas in my life understand more about their bodies, the labor process, and what things are really in their control when it comes to their pregnancy, labor & delivery, and postpartum period. Induction seems to be a hot topic these days so let’s start there…

As you approach your due date, you may have heard your healthcare provider mention something called a "Bishop Score." Understanding this assessment tool can empower you to make informed decisions about your birth and help you determine which natural induction methods might be most effective based on where your body is in preparing for labor, as compared to medical induction techniques. We want your body to worth WITH your baby in labor, not fight each other!

What Is the Bishop Score?

The Bishop Score is a standardized system that healthcare providers use to evaluate whether your cervix is "favorable" (ready) for labor. Developed in 1964 by Dr. Edward Bishop, this scoring system examines five key factors during a pelvic exam: cervical dilation (0-3 points), cervical effacement or thinning (0-3 points), cervical consistency from firm to soft (0-2 points), cervical position from posterior to anterior (0-2 points), and fetal station measuring how far baby has descended in the pelvis (0-3 points). The total possible score ranges from 0-13 points. The higher the score, the more your body is ready for labor.

Score 0-4 (Unfavorable): Your cervix isn't yet ready for labor. Natural methods may help encourage cervical ripening but are less likely to trigger active labor immediately.

Score 5-7 (Moderately Favorable): Your body is starting to prepare for labor, and natural induction methods may be more effective at this stage.

Score 8-13 (Favorable): Your cervix is ripe and ready! You're likely to go into labor soon spontaneously, and natural induction methods have a much higher success rate than at a lower score.

Natural Labor Induction Methods Based on Your Bishop Score

The key to successful natural induction is matching your methods to your body's readiness. What works for a favorable cervix won't necessarily work (and could even be counterproductive) when your cervix isn't ready yet. Here's how to approach natural induction based on where you are:

Low Bishop Score (0-4): Focus on Cervical Ripening

When your cervix isn't yet favorable, the goal is gentle cervical ripening rather than trying to trigger contractions. Eating dates (about 6 per day starting at 36 weeks) has research showing it may improve cervical ripening and reduce the need for medical induction. Evening primrose oil (1500-2000mg daily in final weeks) is recommended by some midwives to soften the cervix, though always discuss with your provider first. Red raspberry leaf tea won't induce labor but may help tone the uterus. 1-3 cups daily in the third trimester is recommended; although drinking more won’t be harmful if you enjoy the taste! Don't forget that stress hormones can inhibit labor, so focus on gentle activities, adequate sleep, prenatal yoga, meditation, and overall stress reduction to help your body relax into the process.

Avoid aggressive methods like nipple stimulation or castor oil at this stage, as they may cause strong contractions before your cervix is ready, potentially leading to exhaustion or fetal distress. I had a lot of personal success with this tincture in the last few weeks of my second pregnancy, but definitely talk with your provider about taking it (I did have a 90 minute labor, remember! And I wouldn’t recommend that for everyone haha)

Moderate Bishop Score (5-7): Gentle Encouragement

At this stage, your cervix is ripening and you can try methods that both continue cervical preparation and may encourage contractions. Regular walking (30-60 minutes daily, including gentle hills or stairs) helps baby descend into the pelvis and increases pressure on the cervix. If your water hasn't broken and your provider approves, sexual intercourse can help through multiple mechanisms: semen contains prostaglandins that soften the cervix, orgasm releases oxytocin (which can trigger contractions), and nipple stimulation during intimacy also releases oxytocin.

Acupuncture has some research supporting its use for labor induction when the cervix is favorable—seek a licensed acupuncturist experienced in prenatal care. If you need a southern NH recommendation, I love mine and I’d be happy to pass her information along! Your birth provider can also perform membrane sweeping during a cervical exam, which separates the amniotic sac from the cervix and releases prostaglandins. Studies show this can increase the likelihood of spontaneous labor within 48 hours.

High Bishop Score (8+): Active Methods

With a favorable cervix, you can try more active methods to trigger labor. Nipple stimulation is one of the most evidence-supported natural methods—it releases oxytocin, the same hormone that causes contractions. Gently roll or massage one nipple for 5 minutes, then take a break for 5 minutes, repeating for up to an hour, 2-3 times daily. This can cause very strong contractions, so monitor yourself carefully and stop if contractions become too frequent or intense.

Bouncing on a birthing ball, doing figure-8 hip movements, and pelvic tilts can help baby move down and put pressure on the cervix. Curb walking (placing one foot on a curb and the other on the street while walking) creates asymmetric movement that can help position baby optimally and increase pelvic pressure. Sexual activity at this stage combines prostaglandins, oxytocin, and physical activity that may be enough to trigger labor.

Safety First

Always consult your healthcare provider before trying any induction method. Natural doesn't always mean risk-free. You should not attempt labor induction if your baby is not full-term (before 39 weeks without medical indication), you have placenta previa or other complications, you've had a previous cesarean with a classical incision, baby is in breech or transverse position, you have an active herpes outbreak, your water has broken (some methods increase infection risk), or you're having vaginal bleeding.

Contact your healthcare provider immediately if you experience regular painful contractions 5 minutes apart for an hour, your water breaks (especially if fluid is green, brown, or foul-smelling), decreased fetal movement, vaginal bleeding beyond bloody show, severe abdominal pain, or fever and chills. Be very transparent with your provider during this whole process. This post is meant to be educational, not taken as medical advice.

Trust Your Body's Timing

Your Bishop Score is a helpful tool for understanding where you are in your journey toward labor, but remember that every pregnancy is unique. A low Bishop Score at 39 weeks doesn't mean anything is wrong—it simply means your body needs more time before it’s ready to go into labor. Trying to force labor before your body is ready rarely works and can sometimes lead to unnecessary interventions. Be patient, and enjoy the last few weeks and days of pregnancy before you meet your baby! Stay in close communication with your healthcare team, trust your body's wisdom, and know that your baby will come when the time is right.

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider before attempting any labor induction methods.

Sources:

Allyson Owen
Previous

The Golden Hour & Newborn Breast Crawl: Why This Magical First Hour Matters
Next

Should I Take A Prenatal?